Insights on Veteran Wait Times and Appointment Cancellation Analysis

V Veteran eteran Wait Times and Appointment Cancellation Wait Times and Appointment Cancellation Analysis: Insights Analysis: Insights- -to to- -Action Action 6146 6146 Evan Albert, Director of Measurement and Data Analytics Evan Albert, Director of Measurement and Data Analytics Dept. of Veterans Affairs, Veterans Experience Office Dept. of Veterans Affairs, Veterans Experience Office Evan.Albert@va.gov Evan.Albert@va.gov Data Innovation Workshop Data Innovation Workshop February 23, 2023 February 23, 2023 For Internal VA Use Only Working Draft, Pre-Decisional, Deliberative Document

Cardiology Cardiology (303) Facilities with Highest Average Wait Time Facilities with Highest Average Wait Time From PID Appointments Over 40D (Count) Total New Pt Appointments (Count) Proportion of Appointments Over 40D Average Wait Time from RD (Days) Average Wait Time from PID (Days) Station (Prop Rank) (Avg WT Rank) 108 141 77 86 84 (593) Las Vegas, NV HCS (4) (4) 262 435 60 55 52 (663) Puget Sound, WA HCS (11) 1/1/2021-2/1/2023 I got my appointment on a date and time that worked for me 80.4% I am satisfied with the service I received from [Facility Name]. 83.9% Station Response Count Outpatient Trust Score (Prop Rank) (Avg WT Rank) (593) Las Vegas, NV HCS (4) (4) 227 89.4% 373 88.7% 87.3% 86.1% (663) Puget Sound, WA HCS (11) 16,557 91.0% 85.2% 88.2% Nationwide

GI Procedures GI Procedures (321) Facilities with Highest Average Wait Time Facilities with Highest Average Wait Time From PID Station Appointments Over 40D (Count) Total New Pt Appointments (Count) Proportion of Appointments Over 40D Average Wait Time from RD (Days) Average Wait Time from PID (Days) (Prop Rank) (Avg WT Rank) 35 116 38 128 92 91 319 66 198 42 (598) Little Rock, AR HCS(8) (1) (503) Altoona, PA HCS (12) 1/1/2021-2/1/2023 I got my appointment on a date and time that worked for me 75.0% 83.3% I am satisfied with the service I received from [Facility Name]. 75.0% 100% Station Response Count Outpatient Trust Score (Prop Rank) (Avg WT Rank) (598) Little Rock, AR HCS(8) (1) (503) Altoona, PA HCS (12) 40 15 90.0% 100% 13,548 92.3% 88.5% 89.8% Nationwide

Womens Health Women s Health (322/704) Facilities with Highest Average Wait Time Facilities with Highest Average Wait Time From PID Appointments Over 40D (Count) Total New Pt Appointments (Count) Proportion of Appointments Over 40D Average Wait Time from RD (Days) Average Wait Time from PID (Days) Rank By Prop Over 40D (637) Asheville, NC HCS (2) (7) 9 11 82 54 55 (590) Hampton, VA HCS (19) 25 58 43 44 36 1/1/2021-2/1/2023 I got my appointment on a date and time that worked for me 88.9% 75.0% I am satisfied with the service I received from [Facility Name]. 88.9% 72.6% Station Response Count Outpatient Trust Score (Prop Rank) (Avg WT Rank) (637) Asheville, NC HCS (2) (7) (590) Hampton, VA HCS (19) 47 203 93.6% 78.3% 11,803 83.6% 81.6% 81.1% Nationwide

Subcategory Clustering Impact on Quality of Care Time Friction Phone System Customer Service/Satisfaction with Care Timelines Multiple Cancellations Same Day Cancellations Technology Communication Administration *Travel BLUF: The team identified three general clusters or concepts among the subcategories that we ve named Time, Friction, and ImpactonQuality of Car 5

Veterans sometimes leave comments in the Outpatient Services Survey related to cancelled or rescheduled appointments. The table below reflects a breakdown of comments by theme in (12/1/2022 1/1/2023) Subtopic Overview Theme Response Count Trust Score % Compliments % Concerns % Recommendations Administration 125 81.6% 63.2% 26.4% 10.4% Communication 73 49.3% 15.1% 56.2% 28.8% Customer Service 331 79.8% 63.4% 26.0% 10.6% Multiple Cancellations 51 51.0% 11.8% 78.4% 9.8% Phone System 569 57.6% 17.9% 63.3% 18.8% Same Day Cancellation 47 78.7% 40.4% 36.2% 23.4% Satisfaction with Care 67 76.1% 41.8% 29.9% 28.4% Technology 107 64.5% 10.3% 57.0% 32.7% Timelines 459 54.7% 15.5% 70.8% 13.7% For Internal VA Use Only Working Draft, Pre-Decisional, Deliberative Document

Cancellation Comments Outpatient Services Surveys: Cancellation Comments by Month 3000 71.0% 70.0% 2500 69.0% 2000 Number of Comments 68.0% Trust Score 1500 67.0% 66.0% 1000 65.0% 500 64.0% 0 63.0% Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-22 1095 Feb-22 763 Mar-22 771 Apr-22 857 May-22 822 Jun-22 1786 Jul-22 2384 Aug-22 2404 Sep-22 2126 Oct-22 1835 Nov-22 2645 Dec-22 1949 Cancellation Comments Cancellation Comments Trust Score 68.6% 69.7% 70.0% 70.0% 69.5% 65.6% 68.9% 66.8% 68.0% 68.8% 67.7% 67.2% 7 Axis Title Cancellation Comments Cancellation Comments Trust Score

Causes Analysis of Time Veterans inferred that staff shortages are the primary cause of cancellations and delays. Many veterans stated that the coronavirus pandemic has increased the frequency of cancelled appointments. Common Recommendations Fewer cancellations Shorter delays for appointments Hiring more staff Online scheduling More Phone Visits 8

Summary Analysis of Time Cancellations are such a negative topic because appointments are difficult to obtain. Veterans can feel as if they are being punished when they lose their appointment, particularly with little notice, because they know it could be weeks or months before they can reschedule. 9

Causes Analysis of Friction Veterans inferred that staff shortages or lack of interest were the main cause of friction such as long phone wait times or non-returned phone calls. Veterans generally wanted to reduce the number of steps and complexity to receive an appointment such as being able to reschedule appointments online or a single direct number to call when cancelled. Additionally, many veterans questioned why the onus was on them to reschedule and not simply scheduled automatically at the time of cancellation. Common Recommendations Shorter phone wait times Automatic rescheduling at time of cancellation Clearer location instructions Electronic medical portal 10

Summary Analysis of Friction Veterans view anything that makes the process of rescheduling longer or more complex negatively. Shorter phone wait times was the most common suggestion to improve ease. 11

Key Findings Analysis of Impact on Quality of Care Impact on Quality of Care was the least numerous but most negative cluster. Veterans were particularly concerned if they believed that the cancellation and delay impacted the quality of care such as: Multiple cancellations delaying a time sensitive issue such as physical therapy. Running out of medications between appointments. Inability to receive mental health services during a time of crisis. Multiple Cancellations 12

Summary Analysis of Impact on Quality of Care The most negative comments were by veterans who believed that the cancellation and delays impacted their quality of care such as those going through a mental health crisis or were at risk for losing their medications. 13

Conclusion and Recommendations Cancellation of Appointments are a negative predictor of trust due to the long wait time between rescheduling. This effect is amplified if the veteran believes the delay will negatively impact the quality of their care such as jeopardizing mental health or medication refills. In addition, the process of rescheduling is viewed by many as unnecessarily difficult due to long phone wait times or lack of automatic rescheduling. Common Veteran Recommendations Fewer cancellations Shorter delays for appointments Hiring more staff Electronic medical portal Better online system Clearer instructions of location 14